Medical Application Forms
341 Templates
Chiropractic Intake Form
A Chiropractic Intake Form is a document that is normally completed by the patient before undergoing a chiropractic session. This helps the chiropractor to identify the needs of the patient and to plan his/her way of care.This Chiropractic Intake Form has form fields that ask for the patient information, emergency contact person, personal doctor's information, authorization, and e-signature. It also asks for the purpose of visit, current health condition, past medical history, current medications, and previous hospitalization. This form template is using the E-Signature widget to capture the digital signature from the patient.
The authorization and consent section is using the Text tool to display static content that is normally used when providing important information or instruction. This template is also using the Configurable List widget to ask the medications the patient is currently taking. This widget allows the user to add more medications as needed. Our forms can be used to collect sensitive patient information by upgrading to a HIPAA account. This allows you to securely store patients' health information which is encrypted automatically.